Cross-country comparisons of population health remain a substantial challenge even using objectively measured biological health markers. This project will have a significant and sustained impact on addressing this key scientific and policy challenge. This application addresses the top 3 recommendations from a recent National Academy of Science review that highlighted the surprisingly poor US health outcomes as compared with those of most other major developed countries : (1) improve the quality and consistency of data sources available for cross-national health comparisons (Aim 3), (2) refine analytic methods and study designs for cross-national health research (Aims 3-5) and (3) initiate research devoted to understanding factors responsible for the US health disadvantage (Aims 1 & 2). We propose to harmonize the growing body of biomarker data from a number of developed and developing countries to increase the source of information on health differences in these increasingly important contributors to world economic, aging and health trends. Crucially, to accomplish our aims, we will implement critically needed cross-calibration of country-specific biomarker data to allow for direct comparative research based on objectively measured health parameters. This will move comparative health research beyond prior efforts that were largely restricted to available mortality or self-report data. The proposed aims of this R01 will result in harmonization of objectively measured biomarker data for population-based samples of adults in 19 developed and developing countries. Biomarkers included in the current analyses (C-reactive protein [CRP], glycosylated hemoglobin [HbA1c], HDL and total cholesterol) reflect major pathophysiological processes linked to major causes of morbidity and mortality. Specific aims of the current project include: implementing cross-calibration/harmonization of biomarker data for 11 major population-based health surveys representing 19 countries; documenting and disseminating methods to produce harmonized biomarker data for use by the broader research community; and illustrating the impact of calibration by describing and comparing cross-national differences in key biological risk profiles based on raw and calibrated data and describing and comparing cross-national differences in relationships between key demographic and socio-economic characteristics (e.g., age, sex, education, economic resources) and distributions of the 4 biological parameters based on raw vs. calibrated biomarkers. Proposed aims will result in a set of publicly available, cross-calibrated data on HbA1c, lipids and CRP for 11 major population health surveys representing 19 countries along with findings from analyses leveraging those data that address questions relating to both the relative health status of the US and relationships between economic development and health.